Adenoviruses in Intestinal Transplantation; UNMC Experience.

Background: During the past few decades, adenoviruses (AdV) have emerged as important pathogens in the intestinal transplant (IT) recipients. The aim of the study was to assess the risk factors for AdV disease and compare outcomes in the IT patients with AdV disease versus AdV asymptomatic infection. Methods: Retrospective study of recipients who received a transplant that included intestine and tested positive for AdV between January 1st 2004 and March 12th 2014. The patients were divided in 2 groups: AdV asymptomatic infections and AdV disease. Wilcoxon rank – sum was used for continuous variables and chi – square tests or Fisher exact tests for the categorical variables. Survival was analyzed by Kaplan–Meyer method and log–rank tests. Results: 81 IT recipients were included, with the mean age of 4.72 years (SD 9.97); 49.38% were males; 22.22 % of the patients were diagnosed with AdV disease. Allograft types: 74.07 % of the patients underwent multivisceral (liver/small bowel/pancreas) transplant and 25.93% of the cases were small bowel. 43.21% of the recipients were cytomegalovirus (CMV) sero-positive. Median time from transplant to AdV positive testing was 213 days (4–2653 days) in the asymptomatic infection group and 107.5 days (11–1649 days) in the AdV– disease group. Table 1 presents the risk factors for AdV disease vs. asymptomatic infection.FigureTable 2 describes the outcomes of the two groups.FigureConclusion: There was a statistically significant higher mortality in the AdV disease group compared to the asymptomatic AdV infection group, suggesting that AdV may play a role in the outcomes of the IT recipients. References: 1. D. F. Florescu, J.A Hoffmann and the AST Infectious Diseases Community of Practice: Adenovirus in Solid Organ Transplantation American Journal of Transplantation 2013; 13:206 – 211 2. Rebecca J Pinchoff, Stuart Kaufman et al: Adenovirus infection in Pediatric Small bowel transplantation recipients Transplantation. 2003 Jul 15;76(1):183-9 3. Diana F. Florescu, Monirul K. Islam et al: Adenovirus infection in Pediatric Small Bowel Transplant Recipients Transplantation 2010 Jul 27; 90(2):198-204 4. J.A Hoffman Adenoviral disease in pediatric solid organ transplant recipients Pediatr. Transplantation 2006: 10: 17 – 25 5. Gwenn E. McLaughlin, Spiros Delis, Lutifat Kashimawo, G. Patricia Cantwell et al : Adenovirus Infection in Pediatric Liver and Intestinal Transplant Recipients: Utility of DNA detection by PCR American Journal of Transplantation 2003; 3: 224 – 228 6. Mariana Parizhskaya, Janet Walpusk et al: Enteric Adenovirus Infection in Pediatric Small Bowel Transplant Recipients Pediatric and Developmental Pathology 4, 122 – 128, 2001